The lifestyle drug debate

July 18, 2005|By Ellen Goodman

BOSTON - You have to say that the drug companies asked for it. I mean really asked for it. Remember when Viagra first came on the market? The spokesman was Bob Dole, veteran, Senate leader and prostate cancer survivor, who urged other men to talk to their doctors about erectile dysfunction. The slogan was: Courage.

Fast-forward through the millennium. The spokesman now is a hunky 40-something guy and a slogan that says: "Keep that spark alive."

The message today is less about disease and more about delight. We've seen ads for erectile dysfunction drugs that feature one man throwing a football through a swinging tire and another getting his mojo back while window-shopping for lingerie. We have a leading lady oozing her satisfied testimonial to Levitra's "strong and lasting" effects. We have romantic scenes with the Cialis tag line: "When the time is right, will you be ready?"

The only warning missing from the stream of side effects listed in these ads was to the drug companies themselves. Beware: If you pitch Viagra, Cialis and Levitra as lifestyle drugs, you can't complain when they get targeted as lifestyle drugs. It shouldn't have been a surprise when the House of Representatives voted to ban Medicare and Medicaid payments for erectile dysfunction drugs.

It happened soon after the brain-numbing news that 800 sex offenders in 14 states had been given Viagra under Medicaid. Paying for Viagra for sex offenders is like funding assault weapons for impoverished felons. But in this case, the vote was less about sexual abuse than sexual recreation.

As Rep. Steve King of Iowa put it, "We provide drugs through Medicare and Medicaid that are lifesaving drugs; we don't pay for lifestyle drugs."

At the heart of it, this is a conversation about rationing. I don't know anyone who thinks the government should pay for hair replacement drugs, nail fungus treatments or cosmetic surgery. But what exactly is a lifestyle drug? Is there a difference between medicine that enhances our "lifestyle" and our "quality of life," and our life itself?

A drug that reduces the nausea from chemo doesn't save lives. Reconstructive breast surgery after a mastectomy doesn't save a life. A nose job to meet beauty standards may be a lifestyle choice, but what about a nose job after a car accident? When is a cataract operation lifesaving and when is it "merely" life-enhancing?

There are many, such as Jonathan Weiner, a health policy professor at Johns Hopkins, who believe that "we should not be paying for sex for elders as long as we aren't paying for basic coverage for everyone." But the issue of coverage for everyone isn't even on the table.

While we talk about cost containment for sex, we haven't even begun to think about what we'll do with the truly expensive drugs coming down the pike. Some of the new cancer treatments can cost $100,000 in order to prolong life for a few weeks or months. How does a country divided over Terri Schiavo's fate wrestle over the cost of that "lifesaving" health care?

I have no interest in using my tax dollars so a perfectly normal 70-year-old can be ready whenever "the time is right." On the other hand, sex is not just a Cialis ad. One of the reasons why many men close their eyes to prostate cancer is the fear of impotence. It's possible and sensible to distinguish between the dysfunction caused by disease and the superfunction that urges 70-year-olds to behave like 40-year-olds. We can fund one and not the other.

For the moment, drug companies have produced their own advertising blowback. It's too easy to attack the notion of government-funded sex. But anyone who embraces the matter of health care costs and choices had better remember the very first tagline on this subject: Courage.

Ellen Goodman is a columnist for The Boston Globe. Her column appears Mondays in The Sun.